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M R C P > Respiratory > Flashcards

Respiratory Flashcards

1
Q

obstructive and restrictive FEV FVC patterns

A

Obsrtuctive: ↓ FEV
restrictive: ↓FVC

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2
Q

type of hypersensitivity reaction atopic asthma

A

type 1 hypersensitivity

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3
Q

eg leukotreine receptor antagonist

A

montelukast

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4
Q

alpha antitrypsin defiiency associated with which disease

A

emphysema
chromosome 14

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5
Q

red puffers= ??
blue bloaters = ??

A

red puffers= emphysema
blue bloaters= bronchitis

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6
Q

what would ABG show on blue bloater

A

type 2 resp failure, are INSENSITIVE to co2

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7
Q

Ix for COPD

A

post bronchodilator spirometry and assess severity

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8
Q

spirometry 9obstructve or restrictive pattern with bronchiectasis

A

obstructive

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9
Q

type of inheritance CF

A

AUTO recessive 1/2500

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10
Q

ghon focus

A

primary infection of TB in lung

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11
Q

TB associated with which derm condition

A

erythema nodosum

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12
Q

Ix suspected TB

A

sputum samples- microscopu, PCR, culture

bronchoscopy with biopsy

CXR- shows upper lobe cavitation, pleural effusion, bilat hilar lymphadenopathy

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13
Q

how to investigate latent TB

A

Mantoux test

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14
Q

what drug causes lower zone lung fibrosis

A

amiodarone , methotrexate

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15
Q

sarcoidosis
who does it afffect
signs and symptoms

serum XXX?= positive

A

affects young ppl african descent
hypercalcaemia
bil hilar shadowing
sob, malaise, weight loss
erythema nodosum

SERUM ACE is raised

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16
Q

chemicals associated with occupational asthma:

A

isocyanates
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes

GF PEPSI

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17
Q

what can rapid aspiration/drainage of pneumothorax cause later on (same admission)

A

re expansion pulmonary oedea

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18
Q

what can rapid aspiration/drainage of pneumothorax cause later on (same admission)

A

re expansion pulmonary oedema

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19
Q

how does hypocapnia affedt oxygen dissocation curve

A

Shifts the oxygen dissociation curve to the left
low co2 shifts LEFT

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20
Q

what would shift the oxygen dissociation curve to the left?

A

Left - Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF, carboxy/methaemoglobin

SHIFT LEFT- EVERYTHING LOWER
SHIFT RIGHT- EVERYTHING RAISED

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21
Q

SMOKING cessation
types of treatment

A

NRT
varenicline=

buproprion

DO NOT TAKE MORE THAN ONE AT A TIME

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22
Q

Nicotine replacement therapy SIDE EFFECTS

A

nausea & vomiting, headaches and flu-like symptoms

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23
Q

Varenicline side effects and MOA

A

a nicotinic receptor partial agonist
top SE- nausea
headache, insomnia, abnormal dreams
avoid in depressed pts self harm risk

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24
Q

which more common- NSCLC or SCLC

A

NSCLC
SCC , adenocarcinoma, large cell anaplastic tumour

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25
Q

SCCs arise from what type epithelium

A

normal pseudostratified ciliated columnar epithelium

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26
Q

recurrent laryngeal nerve palsy symptoms

A

hoarse / change in voice,

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27
Q

pancoast syndrome

A

horners, shoulder pain, oedema, hand arm atrophy

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28
Q

eg of restrictive lung disease

A

sarcoidoisis, pulmonary fibrosis, obesity

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29
Q

ground glass CXR

A

idiopathic pulmonary fibrosis= restrictive

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30
Q

how is FVC, TLCO affected in restrictive lung disease

A

red FVC
reduced TLCO (impaired gas exchange)

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31
Q

gold standard Ix IPF

A

ct

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32
Q

which type hypersensitivity reaction in extrinsic allergic alveolitis

A

type 3 hypersensitivity reaction

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33
Q

common causative agents extrinsic allergic alveolitis

A

farmers lung- MICROPOLYSPORA
Bird fanciers lung- bird poo proteins
malt workers lung- ASPERGILLUS (fungus)

mushroom workers’ lung: thermophilic actinomycetes

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34
Q

onset timeline of extrinsic allergic alveolitis

A

4-6 afterrs post expousre symptom onset,
fever, myalgia
dry cough, SOB, possible wheeze

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35
Q

Tx extrinsic allergic alveolitis

A

o2, oral prednisolone

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36
Q

Ix extrinsic allergic alveolitis

A

CXR- upper zone fibrosis
bronchoalveolar lavage= lymphocytosis
serological assays= IgG antibodies
blood test= NO EOSINOPHILIA

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37
Q

inhalation coal dust causes– ?

A

pneumoconiosis

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38
Q

how does asbestos affect lung

A

Asbestos can cause a variety of lung disease from benign pleural plaques to mesothelioma.

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39
Q

benign asbestos lung

A

pleural plaques

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40
Q

what are pleural plaques
timeline

A

benign, do NOT undergo malignant change

most common form of asbestos lung

NON progressive

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41
Q

what is asbestosis caused by
what is it
timeline

A

HEAVY exposure to asbestos
10 years post exposure
affects lower lung fibrosis

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42
Q

mesothelioma cause

A

caused by light exposure to asbestos

20-40 years post exposure

pleuritic chest pain
unilateral pleural effusion on cxr

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43
Q

X infection is an important CF-specific contraindication to lung transplantation

A

Chronic infection with Burkholderia cepacia

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44
Q

(CFTR) gene which chromosome

A

chromosome 7

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45
Q

HLA associations:

A

HLA-DR1: bronchiectasis
HLA-DR2: systemic lupus erythematous (SLE)
HLA-DR3: autoimmune hepatitis, primary Sjogren syndrome, type 1 diabetes Mellitus, SLE
HLA-DR4: rheumatoid arthritis, type 1 diabetes Mellitus
HLA-B27: ankylosing spondylitis, postgonococcal arthritis, acute anterior uveitis

46
Q

Pulmonary arterial hypertension is defined as an elevated pulmonary arterial pressure of greater than ??? after rest AND exercise

A

25mmHg at rest or 30mmHg after exercise

47
Q

typical treatment for sarcoidoisis

A

nothing, resolves in maj of people

48
Q

indications for starting steroid therapy for sarcoidoisis

A

Indications for corticosteroid treatment for sarcoidosis are:
- parenchymal lung disease
- uveitis
- hypercalcaemia
-neurological or cardiac involvement

49
Q

most common organism causing copd exacerbations

A

h influenzae

50
Q

asbestos fibrosis zone

A

lower zone

51
Q

methotrexate lower or upper zone fibrosis

A

lower zone

52
Q

most common organism bronchiectasis

A

h influenzae

53
Q

egg shell calcification on cxr =?

A

silicosis

54
Q

Buproprion MOA

A

norepinephrine and dopamine reuptake inhibitor, ANDnicotinic antagonist

55
Q

Pneumothorax- what is primary and secondary

A

Primary: A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease

secondary- if existing lung pathology

56
Q

Pneumothorax primary management

A

If rim of air is < 2cm + patient is NOT SOB then discharge

Aspiration should be attempted
if aspiration fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

57
Q

Secondary pneumothorax management

A

> 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain

aspiration if the rim of air between 1-2cm.

If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

58
Q

what organism causes farmers lung

A

farmers lung is a type of EEA

caused by:
Saccharopolyspora rectivirgula

59
Q

Bilateral hilar lymphadenopathy causes

A

B/l hilat lymphadenopathy- something Round comes to yr mind right? Well then Its easy, the causes are, tuber(round); circloidosis,BERRYlliosis,cocciodosos( too may half and full cirlces in the name),then round mass lymphoma

60
Q

Allergic bronchopulmonary aspergillosis

cause
CFs
and management

A

allergy to Aspergillus spores

CFs
asthma
Proximal bronchiectasis
Blood eosinophilia
Immediate skin reactivity to Aspergillus antigen
Increased serum IgE (>1000 IU/ml)

Mx= oral prednisolone

61
Q

Expiratory reserve volume + Residual volume=????

A

= functional residual capacity

62
Q

what is Tidal volume (TV)

A

volume inspired or expired with each breath at rest
500ml in males, 350ml in females

63
Q

Inspiratory reserve volume (IRV) = 2-3 L

A

maximum volume of air that can be inspired at the end of a normal tidal inspiration
inspiratory capacity = TV + IRV

64
Q

Expiratory reserve volume (ERV) = 750ml

A

maximum volume of air that can be expired at the end of a normal tidal expiration

65
Q

Residual volume (RV) = 1.2L

A

volume of air remaining after maximal expiration
increases with age
RV = FRC - ERV

66
Q

Functional residual capacity (FRC)

A

the volume in the lungs at the end-expiratory position
FRC = ERV + RV

67
Q

Vital capacity (VC) = 5L

A

maximum volume of air that can be expired after a maximal inspiration
4,500ml in males, 3,500 mls in females
decreases with age
VC = inspiratory capacity + ERV

68
Q

what is lights criteria used for and what is it:

A

determine if pleural fluid is transudate or exudate
EXUDATE:
protein 30>

TRANSUDATE
protein <30

Lights criteria used when protein levels between 25-30
EXUDATE LIKELY if at least one of:
-pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

69
Q

pleural plaques management

A

no need to follow up- benign

70
Q

upper zone lung fibrosis causes + acronym

A

CHARTS- upper zone fibrosis
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

71
Q

ABG on hyperventilation pt

A

resp alkalosis
all c02 blown off

72
Q

Alpha-1 antitrypsin: PiMZ =

A

carrier and unlikely to develop emphysema if a non-smoker

73
Q

Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of?????

A

of a protease inhibitor (Pi) normally produced by the liver.

alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z

alphabetical

74
Q

What is the most appropriate test prior to starting azithromycin?

A

Before starting azithromycin do an ECG (to rule out prolonged QT interval) and baseline liver function tests

75
Q

diagnostic investigation OSA

A

Polysomnography is diagnostic for obstructive sleep apnoea

76
Q

INITIAL settings for bipap in copd

A

IPAP = 10 cm H2O; EPAP = 5 cm H2O

77
Q

Chlamydia psittaci is treated with ?

A

tetracycline
eg doxy
chlamydia psittaci= bird fancier lung

78
Q

alcoholic+SOB+ cavitating lesion on CXR=?

A

klebsiella

79
Q

CRITERIA FOR ARDS

A

-acute onset (within 1 week of a known risk factor)
-pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
-non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
-pO2/FiO2 < 40kPa (300 mmHg)

80
Q

when to use NIV in COPD

A

T2RF=
high pCO2
a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26)

81
Q

BTS guidelines asthma and NIV?

A

NOT to NIV in asthmatics

82
Q

churg strauss syndrome/Eosinophilic granulomatosis with polyangiitis

CFs

Tx

A

asthma, eosinophilia, presence of mono-/polyneuropathy, flitting pulmonary infiltrates, paranasal sinus abnormalities and histological evidence of extravascular eosinophils.

pANCA positive

LTRAs may precipitate churg strauss

83
Q

best lung func investigation for upper airway compression?

A

flow volume loop

84
Q

SCC lung + high calcium and low phosphate?=?

A

PTHrP is a paraneoplastic syndrome associated with squamous cell lung cancer

Secretion of parathyroid hormone related peptide (PTHrP)

85
Q

what does alpha antitrypsin do in the body

A

protease inhibitor

86
Q

what is lofgrens syndrome

A

Lofgren’s syndrome is an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.

87
Q

high altitude pulmonary oedema (HAPE)Mx

A

decent of altitude
o2
nifedipine

88
Q

cryptogenic organising pneumonia.

A

long symptom weeks to month not respond to antibiotics , respiratory crackles on examination .

not assd with smoking

Bloods show a leukocytosis and an elevated ESR and CRP. Imaging typically shows bilateral patchy or diffuse consolidative or ground glass opacities. Lung function tests are most commonly restrictive but can be obstructive or normal. The transfer factor is reduced.

No tx unless severe= high dose oral steroids

89
Q

4 stages of sarcoidosis on CXR

A
  1. bil Hilar lymphadenopathy
  2. bil Hilar lymphadenopathy +infiltrates
  3. infiltrates
  4. fibrosis
90
Q

what med can be used to prevent acute mountain sickness

A

acetazolomide carbonic anhydrase inhibitor

91
Q

pneumonia in bird keeper: bacteria

A

Chlamydia psittaci
+ conjnctivities

92
Q

factors assd with poor prognosis of sarcoidosis

A

-insidious onset, symptoms > 6 months
-absence of erythema nodosum
-extrapulmonary manifestations: e.g. lupus pernio, splenomegaly
- CXR: stage III-IV features
- black people

93
Q

in sarcoidoisis, why hypercalcaemia

A

increased activation of vit d

94
Q

what type of surgery can be done in alpha anti trypsin def

A

lung vol reduction surgery

95
Q

Causes of a raised TLCO

A

asthma
pulmonary haemorrhage (Wegener’s, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise

96
Q

Causes of a lower TLCO

A

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

97
Q

which type of lung ca most likely to cause cavitating lesions

A

Squamous celll

98
Q

Ix in adults with suspected asthma
>17yo

A

Adults with suspected asthma should have both a FeNO test and spirometry with reversibility

99
Q

triangle of safety for chest drain borders

A

base of the axilla
lateral edge pec major
5th intercostal space
anterior border of latissimus dorsi

100
Q

bipap and cpap both NIV- when to use either

A

bipap- severe COPD, t2rf

cpap- in t1rf eg pulm oedema, covid pneumonitis, OSA

101
Q

Heerfordt syndrome

A

Heerfordt syndrome is a subset of sarcoidosis: a combination of parotid enlargement, fever, and anterior uveitis.

102
Q

Chest x-ray: parenchymal infiltrates with tram track opacities and ring shadows.

A

Oral glucocorticoids are the treatment of choice for allergic bronchopulmonary aspergillosis

103
Q

increase transfer factor (4)

A

raised: asthma, haemorrhage, left-to-right shunts, polycythaemia

lower transfer factor = everything else

104
Q

exposure to WHAT is a risk factor for TB

A

Silica

105
Q

when to give LT oxygen tehrapy in copd abg

A

ABG 2 measurements of pO2 < 7.3 kPa

106
Q

sarcoidosis CXR stages

A

Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

107
Q

cherry red lesion in lung bronchus= ?

A

lung carcinoid

108
Q

most common and likely vessel to bleed during haemoptysis

A

bronchial artery

109
Q

WHEN TO use LTOT in COPD

A

2 ABG readings Po2< 7.3

110
Q

DVT PE managemnt times with DOAC

A

provoked DVT/PE= 3 months DOAC

active cancer and confir,ed dvt/pe = 6 months

M R C P (18 decks)

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